robotic-assisted resection of an intrathoracal parathyroid adenoma · 2019. 5. 9. ·...
Post on 17-Mar-2021
1 Views
Preview:
TRANSCRIPT
Robotic-assisted resection of an intrathoracal parathyroid adenoma
Sarah Steinacher, Markus von Flüe, James Habicht, Alberto Posabella, Beatrice Kern
Materials and Methods
A 75-year-old man, 18 years after a median sternotomy with
coronary artery bypass graft (right internal mammary artery)
due to a cardiovascular disease, was referred to our
department for treatment of primary symptomatic hyper-
parathyroidism. The patient described bone and muscle pain
associated with a beginning osteoporosis. Biochemistry showed
elevated parathyroid hormone (192pg/mL) with a hypercalcemia
(2.7mmol/L). Diagnostic was performed with an ultrasound scan
and a 99mTc mibi scintigraph and showed a 2.7x1.8x1.2 cm
mediastinal parathyroid adenoma, located in the posterior
mediastinum between the esophagus’ wall and the second
thoracic’s vertebra.
Results
Robotic surgery was performed with the da Vinci Xi. In the
theatre, the patient was positioned in the right lateral side, with
a double lung ventilation, allowing a left-side robotic approach.
After the identif ication of the aortic arch and the brachio-
cephalicus trunk, the parietal pleura was opened and the
adenoma was identif ied posterior to the esophagus at the level
of the second thoracic’s vertebra. Careful dissection of the
adenoma was performed preserving the capsule at any time.
After removing the gland, a chest tube was put into the thoracic
cavity. Intraoperative PTH showed a decrease from 192pg/ml
preoperativ to 80pg/ml 15 minutes after removal of the gland.
Histology analysis conf irmed a parathyroid adenoma (weight
1.6 g, size 2.6x1.0x0.6cm).
Conclusion
Robotic (da Vinci)-assisted thoracoscopic parathyroidectomy is a
safe and feasible option to treat an ectopic mediastinal
parathyroid gland, offering an optimal view overall into the
posterior mediastinum. In case of a previous sternotomy as in
our case, the robotic or thoracoscopic technique is an ideal
approach for intrathoracal parathyroid adenomas.
Background
In patients with primary hyperparathyroidism, up to 1-2% show a
functional ectopic mediastinal parathyroid gland1. Although a
majority of them can be treated with a cervical approach, a few
cases require a sternotomy or thoracotomy due to their
challenging location. After the thoracoscopic approach proved to
be a feasible option, the da Vinci robotic systems seems to offer
a new approach to this pathology2. We present a case of a
patient with a primary hyperparathyroidism due to an ectopic
mediastinal parathyroid adenoma who underwent a Robotic
-assisted thoracoscopic surgery.
Picture 1: Location of the ectopic parathyroid adenoma
References:¹Phitayakorn R et al. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg 2016 191(3):418–423.²Balduyck B et . Quality of life after anterior mediastinal mass resection: a prospective study comparing open with robotic assisted thoracoscopic resection. Eur J Cardiothorac Surg 2010 39(4):543–548
Picture 2: The da Vinci robot in the theatre.
top related